County hears proposal to raise ambulance fees to support new ALS program

Cody, an ambulance representative for Anaconda Deer Lodge County, told the commission the proposed increase to the county ambulance fee schedule is intended to make the newly added ALS (advanced life support) program sustainable rather than to generate profit. “So it’s not to make a profit. It’s to become sustainable,” Cody said, describing new medication and equipment costs the county will face.

The presentation drew questions about the last time rates were raised and how list rates translate to collections. A commissioner asked about the history of increases; Cody said rates were updated about four years ago to the Medicare maximum at that time because the county had been charging less than Medicare allowed. Another commissioner noted that even when list rates are increased, many payers (private insurers and contracted rates) determine what they will actually reimburse. “Even though we increase our rates, for the most part, we’re not gonna get paid more…everyone has their rate they pay and that’s just what they pay,” a commissioner said.

County staff emphasized that the proposed schedule is a market-average approach derived from the county’s billing agent, which tracks 22 ambulance services; the county sought a middle position — not the highest, not the lowest. Cody said most Medicare and Medicaid calls are reimbursed at statutory set rates and would be unaffected by the change; the proposal targets private insurance rates.

The commission did not adopt a change at the meeting. Commissioners asked to place the fee-schedule amendment on a future agenda for formal consideration after additional review of potential revenue impact and collection prospects.